EMS Response Time and Deployment-Part 4 of Our Government and Elected Officials Series

Part 4 of our series is very important for government leaders and elected officials to understand. These concepts are critical to helping you in your decision making for budgets and lawmaking.

Having set the general background of EMS and the delivery models in the previous three blog posts, it is important to understand deployment strategies and industry trends towards response in the 911 setting (meaning requests that come through 911 for medical assistance).

• The majority of 911 requests are not time-sensitive emergencies. Time-sensitive emergencies such as an active heart attack, stroke, difficulty breathing, and major trauma account for less than one quarter of these responses.

  
  

• The use of response time as a measurement of EMS effectiveness is changing.

  
  

• The use of lights and sirens to respond to every call or for every transport is no longer an acceptable practice.

  
  

• Of these patients transported, many don't need to go to an emergency room, but there is no payment by insurance companies for treatment at the scene or the recommendation of alternate destinations.

  
  

• In most agencies, dynamic staffing could be considered due to fluctuating call volumes throughout a 24-hour period.

  
  

• 911 response staffing models used for non-911 requests such as transfers from hospital to hospital may prove financially sound for reimbursement but can impact 911 response if not set up effectively.

There is a lot to dig into here, but understanding these concepts will help you to understand the complexity and importance of your decisions. It will also allow you to be educated when your constituents and even other public safety agencies challenge your EMS system.

This post will delve into more detail on the first half of these bullet points, with the remainder being addressed in my next post later this month.

The Majority of 911 Requests for EMS Are Not Time Sensitive

While this is true, the reality is that we are talking about clinical data and not public perception. Consider the example of sitting at a baseball game and one of the kids playing gets hit by a ball and breaks their arm. This would be a common thing that someone may call 911 for, yet it is not a time-sensitive emergency and may not even require ambulance transport. Would you be comfortable with a 30-minute response time for an ambulance? My guess is that it would not be acceptable in an urban area, yet it may be common for even time-sensitive emergencies in a rural area. As government leaders, you have to figure out what your risk and perception tolerance is.

The Independent Government EMS Alliance has 42 member agencies totaling over 2.5 million responses per year. (IGEMSA.Org to see a list of those agencies) Of those responses, approximately 60% involve a transport to the hospital. The 40% not transported include canceled calls, evaluations of patients when requested by a third party, treatment at the scene without transport, and assisting other public safety agencies. EMS has shifted to a front-line healthcare safety net, which in turn has resulted in needing new ways to approach the treatment and transport of patients. Staffing and deploying EMS resources without understanding the changing environment can be a costly mistake. It can also be a major mistake when projecting income from calls for service instead of actual transports.

Response Time as a Measure of EMS Effectiveness

If we look at the four primary public safety agencies (Police, Fire, EMS, and PSAP (dispatch)) that the government provides, most are based on time. While this certainly plays a role in each, consider an example with a police department. What if every request that comes in for assistance was measured by how quickly the officer arrived? If that were the case, an armed robbery and a stalled motor vehicle would be measured by the same timeframe. Over the years, law enforcement has transitioned out of a response time mentality for measuring effectiveness. It is not that rapid response to critical incidents isn't still important; it just means that some non-urgent calls get held for certain periods until an officer becomes available. This has advanced even further with variations such as community service officers rather than police officers assisting and taking reports. There are even online options for making reports.

EMS has entered a similar period where it is used as a frontline safety net for those needing medical assistance. Anyone can call 911 for a medical problem, and an EMS response is going to happen. This may be the homeless person on the street who doesn't have their medications, or a parent who has no transportation but needs to take her child to the doctor because of a fever. It could be an intoxicated person under arrest that law enforcement wants evaluated, or the local nursing home where a patient has fallen, and their staff is not allowed to help them up. EMS is called by employers and retailers when someone has a potential medical issue at their place of business to protect themselves from liability. It is not to say that these are not important tasks, but the ability to respond to these calls in a similar timeframe is no longer sustainable as requests for service grow, expenses outpace insurance reimbursement, and staffing an ambulance becomes more difficult.

Looking at providing EMS service differently can and is happening around the US. Many of our members have services that serve regions and offer alternatives to ambulance response. Many offer tiered response so paramedics are only used on the calls they are needed. Unfortunately, those EMS agencies that are most progressive with this paradigm shift face uphill battles with insurance reimbursement, health system hurdles, and even other government public safety agencies who use "response times" as the true measure of effectiveness and promote it as a sign of failure of EMS in their community. This not only impacts government EMS agencies but also hinders private ambulance services who contract for service with government entities.

The Use of Lights and Sirens on Every EMS Call

The use of lights and sirens when responding to calls or transporting patients has been scrutinized over the years due to driving emergently increasing the likelihood of an ambulance crash. As described in one of the previous sections, the vast majority of EMS responses are for non-time-sensitive situations. There are standard protocols for 911 call takers to follow to determine the seriousness of a call for assistance. Technology has advanced with traffic light-changing technology available in many municipalities for emergency vehicles, decreasing the need for emergent response. There is a time and place for emergency response, but responding with lights and sirens to all calls is no longer an accepted practice and could potentially expose your city or county to liability.

Summary

Part 5 of this blog series will continue with a more in-depth explanation of the last three bullet points above. EMS in the 911 setting is no longer an emergency-only responder. Understanding this will help you as government and elected officials make better-informed decisions.

Changes in the healthcare system have a major impact on EMS. The cost to provide service continues to outpace reimbursement, which impacts the need for tax support. Even the most efficient agencies now need tax support to maintain service. A quick search on the internet will provide examples of decisions to alter EMS delivery models without the decision-makers understanding the changes occurring in pre-hospital care. These are proving to be costly mistakes in some instances.

To the state and federal representatives following this blog: There are very efficient solutions that EMS could implement to improve and make healthcare more cost-effective. Unfortunately, we are a very small part of the healthcare system, and many of these changes could impact the bottom lines of hospitals and insurance companies.

The goal of this blog is to provide a simplistic understanding of EMS in the government setting. There are many great organizations working on changing things in a coordinated fashion. On March 25th and 26th, the National Association of Emergency Medical Technicians (NAEMT) will be in Washington D.C. for EMS on the Hill Day. For those of you in Washington, every state will have representatives there to meet with their state's elected officials. Collaboration between all EMS delivery models and organizations allows for a unified message. EMS on the Hill Day is a collaboration between NAEMT, the American Ambulance Association, International Association of Fire Chiefs, National Association of EMS Physicians, American College of Surgeons, and the National Registry of Emergency Medical Technicians. Take the time to listen to the needs and suggested path forward offered by these groups.